- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.42 / $3,983.00 / $10,709.10
| Facility | | $1,480.42 | $3,983.00 | $10,709.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $16,655.00 / $29,882.70
| Facility | | $3,315.00 | $16,655.00 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.70 / $1,022.50 / $1,265.56
| Facility | | $796.70 | $1,022.50 | $1,265.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.08 / $1,017.08 / $1,017.08
| Facility | | $1,017.08 | $1,017.08 | $1,017.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.81 / $100.81 / $100.81
| Facility | AS | $100.81 | $100.81 | $100.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |